given. In the evening there was no improvement; the oil had produced a free motion. The patient was on his back, with his thighs flexed on the abdomen. Pulse, 95; temperature, 102°. Considerable tympanites. Ordered morphia every two hours.

October 2d.-Patient suffering severely. Pulse, 100; temperature, 101°. Diarrhoea set in. Tympanites lessened. A careful examination showed no sign of tumor. In the evening became delirious. The delirium was of violent form. Pulse, 120; temperature, 104°. Had a chill. Quinia given in tengrain doses.

October 3d.-Was seen by Dr. F. N. Otis in consultation. Pulse, 120; temperature, 1013°; respiration, 20. Abdomen tense and tympanitic. Delirium continued, but of a milder form. The symptoms seemed to point to perityphlitis, but resembled also typhoid, of which several cases had recently occurred in the vicinity. Dr. Otis favored the view that the patient was suffering from perityphlitis.

October 4th.-Tympanites entirely subsided. Mild delirium still present. Skin clammy; pupils dilated. In the afternoon Dr. H. B. Sands saw the patient. A careful examination of the abdomen and rectum failed to show any trace of disease in the ileo-cæcal region. Dr. Sands was of opinion that the case was probably meningitis, and that the abdominal symptoms were reflex in character. A slight convulsion occurred while the examination of Dr. Sands was being made. During the night, convulsions of a more severe character appeared.

October 5th.-Pulse, 90; temperature, 101°. Skin cool and moist. Much quieter. Takes a small amount of nourishment. Dr. Draper was called in consultation, and inclined to the opinion that the patient was suffering from typhoid fever, but subsequently agreed with Dr. Otis that the disease was perityphlitis, resulting in abscess. It was conceded that the brain symptoms were due to septicemia.

October 6th.-Pulse, 125; temperature, 104°. Condition slightly improved. Subsequently exhaustion supervened, and resulted in death on October 7th.

Autopsy. There were no changes in the brain sufficient to give rise to the cerebral symptoms occurring in the course

of the disease. On opening the abdomen the peritoneum was healthy. The lower part of the ileum slightly congested; the cæcum and ascending colon markedly congested. The cæcum and appendix vermiformis firmly bound down by adhesions. which, when removed, showed the presence of an abscess in the cellular tissue behind the cæcum. The abscess burrowed into the sheath of the psoas muscle, and contained about six ounces of pus. The appendix vermiformis presented two perforations on its posterior surface, and within it was a hard fecal mass. There was no nucleus to the fecal impaction.

An interesting point in connection with the case was the disappearance of all signs of perityphlitis and the occurrence of cerebral symptoms when the patient was examined by Dr. Sands.

Epithelioma of Lower Lip.-Dr. SATTERTHWAITE presented, on behalf of a candidate, a specimen of epithelioma of the lower lip, with history. A man, aged forty, in ordinary health, noticed during July, 1874, a small, hard pimple near the angle of the right half of the lower lip. There was but little pain felt in it unless it was irritated by the presence of a cigar. The patient was in the habit of smoking twenty cigars a day, but did not smoke a pipe. For three years the pimple remained stationary. He had it treated, however, by the application of nitrate of silver and sulphate of copper, but without result. In June, 1877, the pimple began to grow slowly, and after four months measured half an inch in diameter. It was then decided to be epithelioma, and removed by a V-shaped incision. There was no recurrence till January, 1878, when a painful nodule was noticed in the middle of the lower lip. This became ulcerated, and manifested a tendency to extend. A second operation similar to the first was performed on January 30th, and after four days union had taken place. A microscopical examination showed it to be a recently-formed epithelioma. There was no connection between the first and second nodules, as the distance between the first cicatrization and the second nodule was half an inch.

Aneurism of the Heart.-Dr. HEINNEMAN presented an interesting specimen of aneurism of the heart. The patient was a woman aged thirty-three years, who had been an inmate of

Roosevelt Hospital during 1874 and 1876. The history of the case was not so definite as might be wished. It pointed to some thoracic trouble, indicated by pains in the precordial region as far back as 1869. When she was examined in hospital in 1874, there was a strong left radial pulse, with a systolic murmur at the base and apex. In 1876 the heart was found to be enlarged. Death took place from exhaustion. At the autopsy the pericardium was found to be adherent. The right auricle and ventricle were dilated, also the left ventricle. There was tricuspid and mitral insufficiency, with stenosis of the aortic and pulmonary openings. The heart when examined presented the most interesting lesion in the left ventricle. At first sight it was difficult to tell where the apex was to be found. This was due to the fact that an aneurism of the left ventricle changed the gross appearances of the organ. The wall of the ventricle forming the aneurism was found to have undergone fibroid degeneration.

Dr. PETERS said that nine or ten such cases had been presented to the society.

Calculus of Bladder; Lithotrity.-Dr. KEYES presented the fragment of a stone which he had removed within an hour by lithotrity, aided by the instrument for washing out the fragments devised by Dr. Bigelow, of Boston. The patient was sixty-three years of age. The first crushing lasted 20 minutes, and, on washing out the bladder, 94 grains were obtained. The second crushing yielded 29 grains. Dr. Bigelow's instrument, which Dr. Keyes exhibited, consists of a large rubber bulb, with dependent glass tube. The bulb is filled with water, and, on compressing it and allowing it to expand, the water is forced into the bladder and returned to the bulb. The fragments which are drawn back into the bulb subside into the glass tube, and thus in a few minutes all fragments can be readily removed from the bladder.

Pleurisy; Aspiration; Death.-Dr.ROBINSON presented specimens obtained from a patient who had suffered from pleurisy. Aspiration was performed three times. The fluid again returned, and the patient died.

Perineal Lithotrity.-Dr. STIMSON presented the kidneys and part of the urethra removed from a man upon whom the

operation of perineal lithotrity had been performed. The patient had suffered for three months from frequent micturition, and latterly for six weeks from incontinence. An examination of the bladder by the rectum showed a large mass near the prostate body. The stone was soft. The walls of the bladder were an inch thick. The bladder was adherent to the symphysis pubis. Death occurred in 48 hours, from uræmia.

Removal of Foreign Body from Trachea.-Dr. BRIDGE presented a button which he had removed from the trachea of a woman. The point of interest of the case was that the button had been in the trachea for a year without giving rise to any trouble. After that period of time it acted as an irritant, causing severe cough. An examination of the case with the laryngoscope showed the button situated in the trachea. It was thought at first to attempt its removal without an anæsthetic, but subsequently it was determined to administer ether. This was done, and the foreign body readily removed.

Lumbo-Colotomy.-Dr. ERSKINE-MASON presented specimens removed from a case of lumbo-colotomy upon whom the operation had been performed 17 months previously. The patient was a woman twenty-five years of age. She entered Bellevue Hospital during September, 1876, stating that she had been delivered of a child by instruments 2 months before. On examination there was found to be a recto-vaginal fistula, with stricture of the rectum, two inches above the anus. There was also a mass of indurated tissue near the stricture, which was thought possibly to be cancerous. The stricture had been treated both by divulsion and incision, but without satisfactory results. The patient suffered severe pain. The operation of lumbo-colotomy was performed on September 20, 1876. Subsequently the pain was relieved, and on examining the stricture it was noticed that it was giving way. She complained occasionally of pain in the hepatic region, but no diagnosis was made out. Death took place 17 months after the operation, from Bright's disease with pleurisy. At the autopsy it was found that there was ulceration of the intestine from the anus to the opening in the colon. An adventitious mass, not cancerous, was discovered near the site of stricture. A calculus was found in the cystic duct.

Stated Meeting, April 10, 1878.

Dr. JOHN C. PETERS, President.

Caries of Cervical and Dorsal Vertebræ without Angular Deformity; Death from Intercurrent Tubercular Meningitis.-Dr. GIBNEY presented on behalf of a candidate a specimen of caries with the following history: A boy, about three years old, was admitted to the Hospital for Ruptured and Crippled, May 22, 1877, having suffered from spinal symptoms for four months previous. There was no history of injury. On admission there was noticed a tendency to opisthotonos, and great care in his motions, while either walking or stooping. There was no angular prominence, nor tenderness along the course of the spine. Appropriate apparatus was applied, and the case progressed favorably till December 4th, when symptoms of tubercular meningitis manifested themselves. An ophthalmoscopic examination was made on the sixth day of the disease, but nothing abnormal was detected. Death occurred on the tenth day. The autopsy was conducted by Dr. E. G. Janeway. An effusion was detected at the base of the brain, of the character usually found in tubercular meningitis. The ventricles were also distended with fluid.

An examination of the spine showed two pear-shaped abscesses, riding the vertebræ anteriorly at the level of the first dorsal. These abscesses communicated with the diseased vertebra. The cartilage of incrustation of the second dorsal vertebra alone remained of the body, while the intervertebral disks were healthy, as were also the articular surfaces. There was also a central osteitis with loss of substance in the body of the fifth cervical, but not so far advanced as in the second dorsal. In the sixth and seventh cervical and first dorsal, the disease presented the characteristics of rarefying osteitis. The cord was normal, both macroscopically and microscopically, with the exception of a slight amount of peri-meningitis. The specimens were of special value in illustrating strumous disease of the vertebræ. The absence of deformity was due to the fact that the diseased vertebræ were not contiguous. The symptoms of opisthotonos were accounted for by pressure on